Malnutrition, Hunger Ravage Displaced Persons In North East

After surviving the Boko Haram insurgency, people of the Northeast now battle life -threatening hunger and malnutrition.

By Tajudeen Suleiman

He was sitting among five other children, eating voraciously with their bare hands from a bowl of maize flour in front of their “house” inside the Nurses’ Village Camp in Maiduguri, where 2,191 internally displaced persons, mostly women and children from communities around Bama, were relocated last June.

Most of the 1, 606 children in the camp are orphans and over 90 per cent of the 550 women are widows. There are only 35 men in the camp.

They had endured weeks of hunger in their various villages and were in severe health conditions before they were rescued and brought to Bama by the military.

Many of them, including the men and women, were too weak to walk, or talk and had to be helped into the vehicles to Bama. It was at the Bama facility that a team of Medecin Sans Frontiers, MSF, found that they had been severely hit by malnutrition – a health condition caused by not having enough to eat, not eating enough of the right things, or being unable to use the food that one ingests.

They were immediately relocated to Maiduguri for treatment

Saving the Children From Hunger

Thirteen-year-old Abacha was one of the 16 children found to be severely malnourished and at the point of death, and had to be rushed to the MSF’s In-Patient Therapeutic Feeding Centre in Gwange, Maiduguri. In a picture taken when he was brought to the feeding centre, he had no flesh on his skeleton; only a thin, pale skin covered the bones.

His eyes had receded into his skull and there was no flesh to cover the teeth. He was too weak to stand on his legs and had to be carried by health officials.

Apart from those at the point of death, a rapid nutritional screening of more than 800 children at the camp in Bama also found that 19 percent were suffering from severe acute malnutrition – the deadliest form of malnutrition. They were all taken to Gwange for treatment before they were relocated to various IDP camps in Maiduguri.

At the MSF In-patient Therapeutic Feeding Centre established in Gwange, a densely populated community on the outskirt of Maiduguri metropolis, doctors and nutritionists employed by the MSF battle to save the lives of more than a hundred children admitted for malnutrition-related illnesses.

The children, all under the age of five, were admitted along with their mothers many of who look equally underfed. Most came from recently liberated rural communities, and had trekked long distances into the camps before MSF or the United Nations Children’s Fund, UNICEF, health officials brought them to the centre for treatment for treatment.

Kadija with her mother

Like Khadija Alhaji who was brought into the centre at just 10 months with a protruded belly, sunken eyes, and legs weakened by months of severe malnutrition.

His mother, Falmata, just 35 years of age, looked much older. For a lactating mother, her chest looked too bare, with a pair of wrinkled breasts. She came into Maiduguri from Bama.

“There is no food for us to eat,” she blurted in response to a question on what brought her child to the clinic. She said Boko Haram destroyed their home and her husband’s cattle when they attacked Gamboru Ngala two years ago.

Since then she had sustained the family by begging for alms. She said her three other grown up children are also begging for alms in Maiduguri.

In another ward, two-year-old Jimme Attom, is also recovering after four weeks of treatment for acute malnutrition. His head is still bigger than other parts of his body.

Two year old Jimme and mother

The eyes stare at visitors from their sockets as if lifeless until he breaks into a smile after a tease. He recoils shyly, dragging his thin legs like two worms coiling up.

His mother, Hamobua, said they came into Maiduguri after Gamboru-Ngala fell to the insurgents. Like many other residents, the insurgents destroyed their means of livelihood and houses. The livestock market where her husband used to work was also closed.

“I and my other five children survive on alms in the city. My husband is also begging for alms because we don’t have anything to eat,” she said, while narrating the ordeal of her family to the reporter.

“We don’t have any food at home, nothing for the baby to eat. I have to go and beg before we can eat,” she said throwing her hands wide open in frustration.

The story of two and half year old Safiya, whose parents came into Maiduguri from Umarari, is no different. Since she was weaned from breast milk nearly nine months ago, she has been fed on gruel (called Kunu in Hausa). Her mother brought her in 20 days earlier with a swollen neck while suffering from diarrhoea.

Safiya, a month after she started treatment

“We don’t have food at home, only kunu (gruel). Since Boko Haram drove us again from Bulabulin area of Maiduguri where we had settled, my husband, who is a traditional barber, has not had any work to do,” her mother lamented.

When she came, Safiya was too weak to eat anything on her own, including plumpy nuts given to malnourished children at the camp. She was put on oxygen support and a feeding tube assisted her to take food directly to her stomach.

After 20 days in the clinic, the swollen neck had disappeared and she could now eat on her own.

The Medical Activity Manager at the facility, Pindar Wakama, said between 50-1000 children were admitted daily due to acute malnutrition, especially at the peak of the rainy season.

He said most of the children brought to the facility also developed other illnesses such as diarrhoea, malaria, measles and pneumonia, which further endangered the lives of the children.

But now that the rains are over, he said there was a reduction in the number of patients registered daily. He said although between 10-15 children were now admitted daily, he warned that the number could increase dramatically in the coming days.

Women who showed visible symptoms of severe malnutrition such as fatigue, weight loss, indicated by loose clothes, belts, jewellery and even dentures, among others are treated before being discharged back to the camps.

It is not yet Uhuru

When icirnigeria.org visited the Nurses’ Village camp two weeks before Christmas, Abacha, like many of the other children at the camp, showed no signs of severe malnutrition and ran gently around the camp either playing football or doing hide and seek games.

But the children are still far from healthy. They showed signs of children growing on only what are available, and not what their bodies need. Some of the children looked slightly thin, weak and walk as if dragging the legs. They showed no vigour of children on healthy diets.

Some also had protruding bellies, dull faces, and watery, sunken eyes. Many had rashes that had chapped and cracked the skin on their heads. They milled around visitors to the camp seeking hand-outs of food.

Kalthum Rawali, one of the widows in the camp, said two of her children were among those diagnosed with severe malnutrition last June. One had swollen stomach and diarrhoea while the other was down with measles. The children looked better now. But she is not convinced they are healthy.

Kalthum and her two children

“The food we get is not enough for us. Although they are trying for us, we are not feeding well. We only eat what we get,” she told the reporter in Hausa, as she drew her crying son closer.

The boy had yellow eyes, running nose and flies swam around his mouth.

The condition is similar in all the 27 official camps inside Maiduguri, including Bakassi, which is the largest. Here, there are 10, 989 children, boys and girls, staying with their families from the five Local Government Areas of Gwoza, Marte, Nganzai, Guza Mala and Monguno. There are also 3, 987 men and 6,116 women.

At this and other large camps in the city, it is not only the children who struggle for crumbs, but also the women, who still battle to feed their families. There is always some confusion whenever relief items are brought into the camps, as the women rush in different directions, all trying to get a piece of the action.

A woman in one of the tents inside Bakassi who spoke to the reporter said the food items given to IDPs are never enough for the families to feed well. Giving herself as example, she said she had nine other children staying with her and her husband.

“They give us the same quantity of food they give others who have less number of family members. My husband and I can survive on one or two meals in a day but the children cannot. That is why some people will have to do anything possible to feed their families,” she stated, showing the reporter a 25kg bag of rice and another 25kg bag of maize flour- given to her family for the month.

Women and children queue for food at the Bakassi IDP camp

Our reporter observed that in nearly all the 27 camps, residents still scramble for food and are forced to line up for several hours to get their ration of food supplies.

At the Bakassi Camp, long queues of women and girls holding plastic bottles were seen when the reporter visited. They were queuing to be served one litre of cooking oil to last for one month.

The Executive Chairman of the State Emergency Management Agency, SEMA, Garba Satomi, promised the reporter an interview but he was not available throughout the seven-day visit.

He, however, approved the reporter’s visit to the camps on Wednesday 21, December 2016, but gave instruction that photographs must not be taken.

Explaining how food items are distributed to the IDPs, a senior SEMA official said that each family gets two bags of 25kg rice or maize flour every month and one litre of cooking oil.

These are provided by the Borno State Emergency Management Agency, SEMA, while each local government provides firewood for IDPs from their areas. The IDPs are classified according to their local government.

“We usually drop two bags of rice or maize directly to their houses or tents, and if we want to serve them other things they are asked to queue up. But once they see or suspect that something has come into the camp, they will start scrambling; there is nothing we can do about that,” he said.

The official also said that claims that the same food ration was given to all IDPs irrespective of family size were false. He insisted that households with smaller family sizes get less than large size families. But another official later confided in the reporter that this is usually done sometimes at the discretion of the officials.

Even, then, while displaced persons who have found themselves in camps may complain of insufficient provisions, they still count among the lucky ones – lucky to at least get some care. There are thousands of displaced persons in remote parts of the state where aid workers still do not have access.

Mass Exodus From Hunger

Fleeing residents troop to IDP camps daily

In September, UNICEF raised an alarm about a looming humanitarian tragedy in the North East if aid does not reach displaced persons trapped in inaccessible areas of the states, especially Borno. A statement by Anthony Lake, UNICEF Executive Director, said an estimated 400,000 children would suffer from severe acute malnutrition over the next one year if they do not receive the treatment they need.

The statement also predicted that 1 in 5 of these children, that is about 80,000, would die, citing rising cases of diarrhoea, malaria and pneumonia.

As scary as this prediction is, Lake added that the “figures represent only a fraction of the suffering, adding that “large areas of Borno State are completely inaccessible to any kind of humanitarian assistance.”

“We are extremely concerned about the children trapped in these areas,” he further stated.

Although the federal government reacted to this alarm by saying it was exaggerated, and that the situation was not as dire as it was being painted, investigations by icirnigeria.org indicate that UNICEF and other aid agencies that have raised the alarm were very much on point.

Camp officials and aid workers who spoke on condition of anonymity in different camps in Maiduguri confirmed that hundreds of displaced persons are received in camps on a daily basis.

In fact, the truth is that hunger, rather than insecurity, is what is now driving thousands of people from their homes and communities into displaced persons camps in Maiduguri where most of the relief items are sent.

Boko Haram insurgency had disrupted farming activities, destroyed crops, food reserves and livestock in most part of the affected states, especially Borno, causing a food crisis that is driving more people from even recently liberated communities into Maiduguri metropolis.

For instance, on Wednesday December 21 when the reporter visited the Bakassi Camp, about 230 persons, mostly women and children, arrived the camp from different communities in Damboa Local Government Area of Borno State.

The new arrivals, elderly men, women and their children told icirnigeria.org how life had become difficult for them in their villages due to lack of food.

They said Boko Haram members running away from the military fire in Sambisa Forest, had taken over their villages forcing them to flee their homes. Some said they could no longer farm or engage in trade and were facing severe hunger.

Bukar Yahuji, 75, could barely stand even with his walking stick. He looked like he had had nothing to eat for weeks. It was in this state that he was forced to trek for more than six hours along with others from his village in search of succour.

“ We are from Kulus, near Damboa. We cannot go out to our farms because Boko Haram are in the bush. We ran out of our village to a town along the Yobe border where the military are stationed. We trekked for six hours. It is from there they brought us here today. We have not eaten anything since yesterday,” he narrated in Hausa.

That same day, an official at the camp disclosed that they received information from the military that 201 more persons were on their way to the camp, asking them to prepare a place for them.

The situation is even worse in dozens of camps that dot the landscape in host communities, set up by helpless displaced persons themselves. The settlements, which can hardly be called camps, are found in many parts of Maiduguri, particularly the outskirts, and they have no official recognition and receive little from official quarters.

Only members of the local vigilante youth groups known as Civilian JTF protect such camps.

Displaced persons, the sick and others running away from hunger, trek into these camps seeking food and urgent medical care every day. One of the biggest of such camps is the Muna Garage, along Gamboru-Ngala Road on the outskirt of Maiduguri, where over 40,000 persons are sheltering.

When icirnigeria.org visited the camp on Thursday December 22, only members of the Civilian JTF were seen around the camp.

The IDPs built the thatched houses by themselves and had to dig pit latrines besides their houses because the zinc latrines provided by UNICEF were not enough to accommodate the daily arrivals.

Officials of the Danish Refugee Council were seen attending to women at the camp. The leader of the delegation said 41,109 persons were registered in the camp.

Out of this 25,213 were women and girls. He said the greatest challenge facing the council is the number of persons who trek into the camp from rural areas with their little luggage and their children asking for food. They don’t ask for where to sleep because they just throw their things on any available space on the field.

UNICEF, MSF and the International Committee of the Red Cross, ICRC, provide health care services and make food donations to residents of the camp, but officials say this cannot be enough to take care of the growing number of new arrivals.

UNICEF Nutrition Specialist, Maureen Gallagher, who spoke to our reporter in Maiduguri said the agency was aware that more people were coming into the camps and other settlements.

“Borno is a very big state and there’s no way we can reach everywhere. But we’re doing what we can together with the government and partners. We’re trying to respond the best way we can. But we know there’s a lot of work to be done,” she stated.

Out of a total of 153,936 children with severe acute malnutrition admitted into UNICEF therapeutic feeding programs from January to November 2016, 87 per cent cure rate was recorded, 10 per cent defaulter rate and 1 per cent death rate.

UNICEF is also offering food and nutrition support to IDPs in all camps through its health clinics located in virtually all the camps in Maiduguri. The feeding programme is a multi-year joint project funded by the UK Department for International Development, DFID.

In November alone, a whopping 13, 441 children were admitted into UNICEF nutrition programme due to severe acute malnutrition in Borno, while in Adamawa and Yobe, only 1,890 and 5, 458 children were admitted respectively.

Forty-three per cent of these are displaced children in camps and those staying in host communities in Maiduguri and Jere local government areas alone, out of 27 local governments in the state.

The forecast is that as more areas become accessible to the military and aid workers, more of these children and their parents may be in dire need of care.

According to Gallagher, UNICEF planned to reach more children as “soon as other areas” of the state are accessible, especially the communities along the border with Niger, Chad and Cameroon.

Federal Government’s Response

A key campaign issue of the All Progressive Congress, APC, led administration of President Muhammadu Buhari was the deteriorating security situation in the Northeast. But while the government had responded vigorously to securing the region by decimating the Boko Haram insurgents, it has failed to take commensurate action to halt the drift into a humanitarian tragedy.

The Nigerian government, its international partners and states in the North east had since early last year validated and adopted a Post insurgency Recovery and Peace Building Assessment Reports on the northeast which estimated that about $9 billion would be needed to rehabilitate public and private infrastructure, social services and economy of the area.

Subsequently, the President set up the Presidential Committee on Northeast Intervention, PCNI, which is to drive the response of the Nigerian Government to implement recovery, social services and economic stabilising programmes contained in the Buhari plan.

It is supposed to coordinate other committees like the Victims Support Fund, the Presidential Initiatives on Northeast and any other.

But investigations revealed that the federal government did not start acting until September last after UNICEF and other international agencies cried out about the humanitarian crisis in the zone.

Even then, government response has been limited to food supplies to the IDP camps. Health care, education, water, economic support and so on have been left for aid agencies and NGOs.

Borno government officials who spoke off-the-record on the issues said the federal government had not shown enough commitment towards addressing the humanitarian crisis in the state.

This was confirmed by Kashim Shettima, governor of Borno during a panel discussion on the North East in Washington DC on October 18. In his speech delivered, the governor said the state was still waiting for the federal government and the World Bank support for the Boko Haram ravaged states.

Officials OF WHO, UNICEF, MSF and ICRC who asked to assess federal government’s response to the crisis refused to comment, saying their focus was to contribute their quota to solving the problem.

How Borno State Government Has Faired

The Borno state government has largely coordinated humanitarian response by not less than 62 aid agencies and NGOs delivering assistance to the state, including ICRC, UNICEF, MSF, the USAID, the World Food Programme, UNHCR, UNFPA, UN-OCHA, the Danish Refugee Council, the Norwegian Refugee Council and Action Against Hunger among others.

These organisations are providing urgent multi-sectorial humanitarian assistance to IDPs in the areas of food, water and sanitation, health and hygiene services, shelter and non-food items, education, protection (including targeted responses for children and Sexual and Gender-Based Violence (SGBV) survivors, early recovery activities, and livelihoods.

However some of the aid agencies confided in the website that while the state government had shown passion for addressing the crisis, government officials have stolen relief items and embezzled cash donations made to the state.

This had reportedly been brought to the attention of the state governor who promised to look into the allegations, but no one has officially been brought to book.

A senior official of one of the international aid agencies told the website that his organisation threatened to pull out of partnership with the state in November last year when officials of a state ministry could not account for relief items for which funds were given.

He said it took a personal plea of the governor before the organisation continued as partner to the state.

The governor Shettima administration has largely concentrated its attention and resources on reconstructing the state infrastructure destroyed by six years of insurgency. The government said over 400,000 buildings were destroyed in the state by Boko Haram.

That is why the administration is currently carrying out reconstruction works in 10 out of the 20 local government areas largely affected by the insurgency in order to restore civil rule and facilitate return of IDPs to their communities.

But residents of the state who spoke to the website criticised the governor for putting infrastructure before human beings. Kaka Gubio, a local government staff, told icirnigeria.org that the people are suffering and need economic empowerment, not roads or government buildings. “The military is yet to fully rout Boko Haram from our towns and villages. What is the need of hurrying to build houses when your people are dying of hunger,” he asked.

Many others who spoke to the website in Maiduguri are asking the same question.